DICOMmunicator HELP

Function Index Links

INSTALLATION INSTRUCTIONS

Database / Image Import Functions,

Viewing Functions,

Image Export Functions,

Teaching File Functions,

Conferencing Functions,

Cooperative Group Functions,

Manager Functions

INSTALLATION INSTRUCTIONS:

Installation of Dicommunicator files is achieved by opening the install.mdb database on the installation disk using Microsoft Access2000. First make sure you are running Windows 95, 98, NT, or 2000 operating systems and have at least 128 Mbytes of RAM. The more RAM you have on the computer, the better it will perform. RAM is more important than CPU speed for this application. Install a full version of Access 2000 on the computer. You will need to decide if you plan on using Dicommunicator on a single computer or want to install it on several computers and share some of the common files between them. If, for example, you want to have the teaching file shared between computers you will install a version of Dicommunicator on each machine and install (one time only) shared files to a server that all the machines can access. The installer function leads you through this process will copy files, register OCX’s, etc. automatically.

After you have run the install program, it will have created Dicommunicator directories and files in the root paths you defined. Dicommunicator uses several databases. There is a code database located at YourLocalRootPath\Dicommunicator\Frontend\DicommunicatorCode.mde. This is the actual Dicommunicator application. Frontend data files (intended to be local to each computer running Dicommunicator) contains among other things the tables defining imaging studies that are resident in the local database. This database is sited at LocalRootPath\Dicommunicator\FrontEnd\DicommunicatorFrontend.Mdb. The third database is intended to be sharable between different computers on the network. It contains references to the network teaching files, window/level presets, etc. There is a copy of this database at YourLocalRootPath \Dicommunicator\Backend\DicommunicatorBackend.mdb. When you are running Dicommunicator on the local machine in isolation, this is the file that should be used rather than a networked copy of this Backend database.

Optimally, Dicommunicator runs in an environment where several computers can contribute data to backend tables on a central server. If you have installed the backend files to a server they will be located at YourNetworkRootPath\Dicommunicator\Backend\DicommunicatorBackend.mdb.

Dicommunicator uses standard Access security and security databases are present in the backend folders (at YourLocalRootPath \Dicommunicator\Backend\Security\DicommunicatorSecurity.mdw and YourNetworkRootPath\Dicommunicator\Backend\Security\DicommunicatorSecurity.mdw). You will need to copy the two shortcuts from the YourLocalRootPath\Dicommunicator\ folder to the desktop and change their paths to reflect your installation. Each of these shortcuts has three paths; 1- The path to Microsoft Access 2000, 2- The path to the code database YourLocalRootPath\Dicommunicator\FrontEnd\DicommunicatorCode.mde, and 3- The path to the security database. The “Dicommunicator Local” shortcut should give the security database path as YourLocalRootPath\Dicommunicator\Backend\Security\DicommunicatorSecurity.mdw. If you are using Dicommunicator with shared network files it is to your advantage to use the networked DicommunicatorSecurity.mdw database so that you don’t need to try and maintain multiple security databases (one for each computer). Set the security database path in the “Dicommunicator Network” shortcut to YourNetworkRootPath\Dicommunicator\Backend\Security\DicommunicatorSecurity.mdw. and launch the application from this shortcut whenever you are connected to the network.

If you set these shortcuts up as described, you will be running the same application regardless which of the shortcuts you use but the security databases will be different for the two shortcuts. For networked versions, having a link to a local security database version will enable you to use Dicommunicator when the network is down or when you have taken the computer off-line.

Once you have set up these shortcuts, attempt to open Dicommunicator by clicking the shortcut. Both security databases come with a login for manager with password manager (Login in as manager and type password manager). As Dicommunicator opens, it will probably not be able to establish links to the Frontend and Backend databases (see above) because their correct paths will need to be specified in the GLOBALS AND PATHS table. The MANAGER FUNCTIONS form will open automatically and you can configure the GLOBALS for your installation by pushing the EDIT GLOBALS AND PATHS button. After editing these values attempt to REATTACH TABLES. If you are having problems with this installation, notify Rich Hanusik at Rhanusik@Qarc.org . The installation programs puts copies of the DicomObjects.ocx (ActiveX) program produced by medical connections in your system folder. You must obtain a license from Medical Connections to legitimately run this program. Contact medical connections at www.medicalconnections.uk for details on licensing.

Database / Image Import Functions (Go To Top)

Delete studies

Query/Retrieve from Dicom archive

Store studies to local database

Read Dicom compliant storage media

Read Dicom images from local/network drives

Import Jpeg or Bitmap images,

Delete studies from local database: To delete studies from the local Dicom Database, open the BROWSE PACS form and select “local” as the QUERY HOST. From the updated list of studies select the study to delete and press the DELETE STUDIES button.

Query and Retrieve studies from Dicom Image archives to the local database: Open the BROWSE PACS form and select the desired Dicom Archive from the QUERY HOST combo box. If you do not see the desired host listed, this means that it has not yet been entered as a possible connection. A system manager can add a new Dicom connection for you from the EDIT COMPUTER CONNECTIONS form. After you have selected the desired query host, specify the conditions of the search. You can specify the last letters of the patient’s name, supply a time interval (last ? days), and/or specify the imaging modality. If you want a specific patient ID or accession number, use the pull down just to the right of the modality label (by default this is labeled “unspecified”) to select Patient ID or Accession Number and type in the desired number in the box below. If you are querying from a Dicom Archive that is large and your search is not specific enough the query will timeout and fail.

Once you have established the search criteria, push the GET PATIENT LIST button. Upon returning, the query results are displayed. If the parameters you specified in the search were specific to Dicom studies, the results window will list studies that matched your criteria. If, however, you only requested a list of patients by typing some text in the PATIENT NAME criteria you will get a list of patient names that match the text you typed. From this list of possible patients select the correct patient name and push the GET STUDY LIST button.

If you want to go beyond the study level and view specific series descriptions, you can select a study and push the GET SERIES LIST button. This feature is particularly helpful in viewing MRI images.

Once you have identified the study or series you are interested in, you can either pull the study to the local database by pushing the RETRIEVE STUDY button or you can view the images directly without saving them to local disk by pushing the VIEW IMAGES button. Before retrieving a study, check the CONFERENCE pull down to see that the conference/scope is correct. By default, the scope is set as “local review”. If you are pulling the study to a conference, select the conference name from the pull down before pushing the RETRIEVE BUTTON. The advantage of pulling the studies locally is that you can pull multiple studies at a time and later view them at your convenience. If you choose to view images directly, the DICOM VIEWER form will be opened and as the images are returned from the DICOM archive they will be displayed. Once you close the viewer, the images are gone unless you choose to store them locally from the viewer.

Store studies sent to DICOMmunicator from other Dicom devices to the local database: Generally speaking, this function happens automatically without any user intervention. The one exception to this is when the study is pulled for direct viewing by pushing the VIEW IMAGES button after selected a specific study from the QUERY RESULTS LIST. In this case, the images are brought directly into the DICOM VIEWER form without being stored locally. If, after viewing, you decide to store some of the images locally, Use the SELECT TOOL to select the images you want to save and push the IMPORT LOCAL button to add the images and their references to the local database.

Read Dicom images from Dicom compliant storage media such as CDROM: If you have images stored on CDROM from a Dicom compliant modality such as a cardiac cath lab or a CDROM previously written by Dicommunicator, you can view these images. Put the CDROM in the drive, wait for it to register itself, and open the BROWSE PACS form. Select “CDROM” from the QUERY HOST combo box and Dicommunicator will read the CDROM directory and return a list of studies on the CDROM. Select the study of interest and push the VIEW IMAGES button.

Read Dicom images from local or networked hard drives: If Dicom images are available on local hard or networked hard drives, you can view them by first opening the BROWSE PACS form and selected “Browse” as your QUERY HOST. A pop up window will immediately appear. Navigate the directory tree of this window to select the directory that holds the images you are interested in. Once you select the folder, Dicommunicator will go through the folder, look for all Dicom images in the folder, and return a list of studies. If there are many images in the folder you have selected, this process could take some time. Once the study list has been returned, select the study of interest and press the VIEW IMAGES button.

Import Jpeg or Bitmap images: These are the only non-Dicom formats that are currently supported. From the MAIN MENU form, push the VIEW NON_DICOM IMAGES button. A pop up window will appear immediately and you will need to navigate to the folder that contains the images you are interested in. Once you have selected the folder, the DICOM VIEWER form will be opened and all jpeg and bmp images in the folder you specified load to the viewer. To import any or all of these images to the local database first SELECT the images of interest then push the IMPORT LOCAL button. The first thing that will happen is that Dicommunicator will check the DICOM compliance of these images and realize that they are not fully DICOM compliant. The system will then open the CONVERT IMAGES TO DICOM form. Once the images have been successfully converted, push the IMPORT LOCAL button again to complete the import.

## Viewing Functions (Go To Top)

#### View Dicom Images

View Bitmap Images

Use Image Display Tools

Select

Scroll

Window/Level

Crop

Rotate/Flip

Measure

Mask

Save

Change Display Format

Scroll though Images

View Dicom Images: Selection of images to be viewed is generally performed from the BROWSE PACS form or the teaching file CASE BROWSER form. Once you have selected the study you are interested in, press the VIEW IMAGES button and the DICOM VIEWER will be opened and the appropriate images will be automatically loaded.

View Jpeg or Bitmap Images: The IMPORT NON-DICOM IMAGES button on the MAIN MENU form will invoke a popup window that will allow you to select the folder containing the images of interest. After selection of the folder, the DICOM VIEWER will be opened and all bmp and jpg images in your selected folder will be loaded. Note that the DICOM VIEWER converts the images to Dicom format automatically but that some important Dicom fields are empty so that if you want to do anything other than view the images (such as export, email, ftp etc.) they will need to be converted to full Dicom. This conversion process will start up automatically when you try to perform one of these functions.

Image Display Tools: Basic image manipulation tools (select, scroll, window/level, crop, rotate/flip) are all implemented with the mouse from the DICOM VIEWER. The ACTIVE TOOL bar is labeled in green. The corresponding tool buttons change the tool that is active. By default, the SCROLL tool is active when the viewer is opened. The active tool will always be labeled in red. Underneath the active tool bar is a legend that tells what pushing the left or right mouse button will do for the currently active tool. To activate a desired tool, simply push its’ button, move the mouse over the desired image, and perform the desired function. After using the window/level, crop, or rotate/flip tools you can save changes to the images so that the next time they are displayed they will have the current display characteristics. This is possible only if the images originate from a local or network hard disc (if you are viewing them from CDROM or you pulled them directly into the viewer from a Dicom archive the changes can not be saved). After any changes to image display is made, the SAVE CHANGES button becomes enabled. Use the Select tool to select the images that you want the save to apply to and push the SAVE CHANGES button.

Select Tool: The select tool is used to select images prior to saving changes to images or performing an export function such as submitting images to the teaching file, emailing images, writing images to CDROM etc. Activate this tool by pushing the SELECT radio button in the ACTIVE TOOL bar. If you push the left mouse button over an image, it will be selected and it’s border will turn red. Pushing the left mouse button over a currently selected image will cause it to be deselected and the red border will disappear. If you want to select all images, press the right mouse button. This will cause a green border to appear, telling you that all images are currently selected. By pushing the right mouse button again, all the images will be deselected and the green border will disappear.

Scroll Tool: The purpose of this tool is to allow rapid sequential display of images. After selecting this tool, move the tool over the image and press to left mouse button down to scoll forward and hold the right mouse button down to scroll backward. The process of scrolling can also be achieved by clicking the IMAGE SELECTOR buttons (labeled with arrows) to move forward, backward, move to first images, and move to last image. Note that if the image being viewed is a multi-frame image such as a cardiac cine or angiogram pushing the scroll tool will change the frame displayed in the current image rather than moving to a new image.

Window/Level Tool: You can change the window/level (brightness and contrast) of the images by activating this tool. Using the left mouse button will change how the current image is displayed while the right mouse button will cause all images to be adjusted. Move the mouse button over the image, hold down the button and move the mouse up and down to adjust the level, and from right to left to adjust the width. When you like the image display, release the button and the tool will deactivate. Note that there is another quick way to adjust image brightness and contrast. The PRESETS pull down will allow you to select predefined window and level values and apply them to all images in the stack. These presets are particularly useful for CT and basic presets are supplied with the software. Note that when presets are set up the modality to which they apply is specified so that you can not for example use a CT Lung preset if you are viewing an MRI. A basic set of presets is included with the software but these can easily be edited and new presets established from the MANAGE PRESETS form.

Crop Tool: The purpose of the crop tool is to improve the overall zoom display of the image. For example, pediatric radiographs frequently include a large area of blank image space around the periphery of the image. To cone down to the desired area of interest and give a more optimal display of this area use the crop tool. After activating the tool, move the mouse pointer over the image select a box or rectangle by placing the pointer on one corner of the box, pushing and holding the mouse button down, and moving the mouse to enlarge the box to the desired size. When you release the mouse, the image will be “cropped”. If you have used the left mouse button to crop, only the display of the current image will be changed. Using the right mouse button will cause all images in the stack to be cropped. When you crop an image, you do not throw away data, it just changes the way the image is displayed. If you don’t like the result of your crop, simply click on the image and it’s original profile will be restored. Note that this cropping does not change the profile of the image window so that you will almost always have some area outside the box you drew included in the image window. The TURN ZOOM ON/OFF button can be used to override the cropping of any image. Pushing this button will cause current cropping parameters to be turned on and off.

Rotate/Flip Tool: To flip or rotate image/images activate the rotate/flip tool and move the mouse pointer over the image. By sequentially pushing the mouse button you will change the display of the image. There are actually eight unique orientations possible so as you continue to push the button these possible configurations will scroll through so that pushing the button eight times will cause the original configuration to be restored. Use the left mouse button to change the orientation of the current image and the right mouse button to change the orientation of all images.

Measure Tool: Dicommunicator will allow you to measure distances, estimate areas and volumes, and measure angles. When you select the measurement tool, a measurement result form is opened and placed in the right upper portion of the screen. View the results of your measurements on this form. Use the left mouse button to make measurements on the currently displayed images. To determine a length, place the mouse pointer on one end of the object to be measured, press the mouse left button down, and while holding down the button drag to the opposite side of the object. As you release the button, the measurement will appear in the results window. The result for the most recently drawn line is given as “Distance 1”. As multiple measurements are taken, the new measurement will always be placed in “Distance 1” and the next to the last measurement will be placed in “Distance 2”. After at least two lines have been drawn, the Area of an elipse with diameters Distance 1 and Distance 2 is given. The angle between the two most recently drawn lines is also given.

To make measurements on multiple images move to the first image that shows the object of interest and push the right mouse button over the image. After moving to the last image in the stack that shows the object, again push the right mouse button over the image. The distance between these two points (z axis distance) is then reported in “Distance 3” of the measurements window. An estimate of the volume of an elliptical cyllindroid with diameters Distance 1, Distance 2, and Distance 3 is given.

Mask Tool: You can use the mask tool to place a black rectangle over any portion of the image. This is useful if there are identifying labels on the image that you want to eliminate to preserve confidentiality. Note that for some modalities that have patient demographics imbedded in the image at a fixed location, your system manager can set up an “automask” so that this black masking will be performed automatically.

After activating the mask tool, move the cursor over the image to one of the corners of the desired mask and draw a rectangle over the area to be blackened by the mouse button down and dragging to the opposite corner. As you release the mouse, the rectangle will be masked. Note that if you use the left mouse button to draw the rectangle, only the current image will be masked whereas the right mouse button will cause the mask to apply to all images.

Save Tool: Images can be saved in one of two modes; save changes in display to all images that are currently selected (they will have either a red or green border), and save the current image as it is displayed as a new image. To save changes to a group of images, first use the SELECT TOOL to select the images you want to change. Next, make the changes (flip, crop, window level, etc.). After the images are as you would like them, activate the SAVE TOOL and place the cursor over the image window and press the left mouse button.

To save the current image (as currently displayed) as a new image, activate the SAVE TOOL and move the cursor over the image window and press the right mouse button. This process will save all labels, masks, etc. as well.

Change Display Format: The default format for display is one on one. Several other formats are available (2 on 1, 3 on 3, etc.). To change the display format, select the desired format from the FORMAT pull down. You can automatically toggle between 1 x 1 and 4 x 4 format by double clicking on the image displayed.

Move through the Image Stack: The SCROLL TOOL can be used to rapidly move up and down a stack of images but this process can also be performed by moving through the images using the IMAGE SELECTOR, PAGE SELECTOR, and FRAME SELECTOR buttons. For each of these button sets there are buttons labeled as arrows to move first, move previous, move next, and move last. The FRAME SELECTOR button set is only visible if the image being displayed is a multi-frame image such as an image from a cardiac cine procedure. The PAGE SELECTOR button set is only useful when the DISPLAY FORMAT is other than 1 x 1. For other formats, pushing the appropriate PAGE SELECTOR button will cause the images to shift by one page rather than by one image at a time. For example, if the format is 2 by 2 and the top left image is image 1 then pushing the next button of the PAGE SELECTORS will cause the top left image to become image 5.

## Image Export Functions (Go To Top)

Make Images Dicom Compliant

Export Images

Email Images

FTP Images

Copy to Clipboard

Convert Non Dicom compliant images to full Dicom: The conversion process is invoked whenever you try to transfer a non Dicom compliant image using email, ftp, local storage, write to CDROM, or when you try to add images to the teaching file. When any of these functions is attempted, Dicommunicator first checks to see if the images are fully Dicom compliant. If they are not, the process is aborted and the CONVERT IMAGES TO DICOM form is opened. You can either enter values for Dicom data fields manually, semi-automatically, or look up pertinent fields from a Dicom archive by selected a study and using it as a template for the conversion process. The CONVERT IMAGES TO DICOM form opens and some default values are set. Note that the fields on this form are the fields that must have valid values for the images to be considered Dicom compliant by Dicommunicator. Pushing the RESET DEFAULTS button will set some of the field’s values automatically. Other fields such as the PATIENT NAME, SEX, DATE OF BIRTH, Etc. must be set manually. Once all of the necessary fields have been filled in, push the DO CONVERSION button to convert the selected images from the DICOM VIEWER to full Dicom format.

If you want to link the images to a particular study or with a particular patient and you know that there are fully Dicom Compliant images available on the same patient in a Dicom Archive available to you, you can use those images as a template (extract information such as SEX, DATE OF BIRTH, etc.). To use this functionality, push the LOOK UP button. This will cause the BROWSE PACS form to open. Find the template study from either local or other Dicom Archive, pull the study to the local archive, and select it. Push the CREATE TEMPLATE button and the pertinent field values will be transferred to the CONVERT IMAGES TO DICOM form. When all fields are correct, push the DO CONVERSION button.

After you convert the images, whatever process you were trying to do when the conversion was invoked will need to be repeated. With the repeat, the process should complete because the images were made fully Dicom compliant by the conversion and the compliance check should not fail.

Export Images: Images can be exported from Dicommunicator to local or networked hard drives, CDROM, or you can send images to electronically to another Dicom device. To export to CDROM, you must have a writeable CDROM and the appropriate path to this device must be defined from the MANAGE GLOBALS AND PATHS form. To send images to a Dicom archive, the appropriate address and Application entity titles must be set up in the ALLOWABLE COMPUTER CONNECTIONS .

Images can be exported in Dicom, Jpeg, or Bitmap formats. Other formats are not currently supported. Images are selected for export by viewing them with the DICOM VIEWER and using the SELECT TOOL. After selecting the desired images, open the EXPORT form by pushing the EXPORT IMAGES button. Images can be exported to any writeable drive (local or network) visible from the system. To export to one of these locations, select “Local” from the EXPORT DEVICE pulldown. If you push the EXPORT IMAGES button without specifying a destination folder a pop up window will appear asking you to navigate to the destination folder. Pushing the BROWSE button will cause this pop up to appear prospectively. The selected path name will appear in the EXPORT PATH text box.

The DEMOGRAPHICS MAPPING pull down determines whether the Name and PatientID fields of Dicom Images will be modified before the export is performed. Selection of “Unmodified” will result in the images being stored without any changes being made to these fields. To protect patient confidentiality, the default for DEMOGRAPHICS MAPPING is “User Defined”. This results in the Name and PatientID fields being changed to the value typed in the FILENAME PREFIX box. Note that the FILENAME PREFIX will also determine the name of the image file stored to disk. The third DEMOGRAPHICS MAPPING option is for “Cooperative Group Mapped”. This is a powerful option that allows the user to map the patient to research study demographics supplied by the cooperative research group. See COOPERATIVE GROUP FUNCTIONS for details.

Select the FILE FORMAT of interest (Jpg or Dcm). The Q FACTOR is a JPEG parameter that balances image quality with compression ratio. A Q factor of 90 or higher will result in approximately 10:1 or 15:1 compression without causing any visible change in image quality. Note that the Dicom standard supports Jpeg compression and that you should specify a quality factor for Dcm images as well as by default Jpeg compression is applied.

By default, only the images selected in the DICOM VIEWER (images with a red or green border) will be exported but this can be overridden by selected “All Images” from the EXPORT GROUP pull down. Also by default, only that portion of the image that is visible in the image window of the DICOM VIEWER will be exported. If the crop or zoom functions have been used the image data that lies outside the image window will not be saved. You can choose to export the whole image by clicking the WHOLE IMAGE checkbox.

Although you can export images to CDROMR simply by selecting “Local” in the EXPORT DEVICE pull down and browse for the path to the CDROMR drive, use of “CDROMR” as the EXPORT DEVICE is preferred because this export mode will perform several additional important functions (create a Dicom Directory on the CD and copy the Osiris Dicom Viewer, help files, and auto-launch files to the CD). These additional files will allow the images to be viewed on any computer, provide html help files to aid in use of the Osiris software, and cause a directory of studies written on the disk to appear automatically when the CD is put in a drive. Note that before writing images to CDROM you must use Adaptec or other CDROM software to configure the CD for writing and that after you have written the images you must again use Adaptec to format the CD for general viewing.

If you want to send Dicom images to another Dicom Device such as a Dicom Archive select “Dicom Archive” as the export device. You must also pick the archive name from the ARCHIVE pull down. If the computer you are interested in isn’t included in this list, a manager can add the computer using from the EDIT ALLOWABLE COMPUTER CONNECTIONS form.

Once all parameters are set, push the EXPORT IMAGES button to perform the export. A progress meter appears to inform you how much of the process is complete. If the images you have chosen for export are not entirely Dicom compliant,

Dicom conversion must be completed before the export can be performed. The EXPORT IMAGES form will be minimized (all parameters you entered will be saved) and the CONVERT IMAGES TO DICOM form will be opened. After you have completed the conversion, push the EXPORT IMAGES button on the DICOM VIEWER again and the IMAGE EXPORT form will again appear with all the parameters you previously set intact. Push the EXPORT IMAGES button again to complete the export.

After finishing the export, you can close the form by pushing the QUIT EXPORT button. If, however, there are other images you want to export and want to preserve the parameters you entered on the form press the SELECT MORE IMAGES button instead. This will minimize the form but keep the parameters intact until the next time you push the EXPORT IMAGES button.

Email Images: Many of the features to email images are the same as for general image export. Refer to documentation of IMAGE EXPORT for general documentation of this process. After selecting images to be sent as email attachments from the DICOM VIEWER, press the EMAIL IMAGES button. The EMAIL IMAGES form will be opened and the form contains several user-defined fields that are in addition to those discussed above for general image export. The name of addressee and their email addresses should be entered in the respective EMAIL TO and EMAIL ADDRESS text boxes. It is highly recommended that a standard convention for entering addressee names be used with “LastName, FirstName” being recommended. The first time you put new values in the EMAIL TO and EMAIL ADDRESS fields, these values will be stored in a table. Each time you email to that address thereafter, a counter will be incremented. The EMAIL TO pulldown can then be used to select the most common email sites from a sorted list (sorted by number of emails sent to that addressee).

Type a text message in the MESSAGE window to be included with your email. Push the EMAIL IMAGES button and the message and attachments will be sent. Note that when large numbers of images are sent, the images are packaged in groups of 20 (i.e. there are no more than twenty image attachments allowed for any one email). An addendum is placed on the message giving the recipient packaging information. For example, the first email generating in transfer of a 42 slice CT scan will have the appended message “Images 1 – 20 of 42” included.

In order to use the email functions, Dicommunicator must have the internet address of an SMTP Email Server entered in the Email entry of the ALLOWABLE COMPUTER CONNECTIONS table. This entry can be made by a manager from the MANAGER form.

Transfer Images with FTP (UNDER CONSTRUCTION): The process of sending images with FTP is almost identical to general EXPORT IMAGES with the exception that you must specify the FTP SERVER from the pulldown and designate a login account and password. Once you select the FTP SERVER, the default account name is filled in for you. You must specify your password in the PASSWORD text box. Note that for the “Anonymous” account, your email address will usually suffice as a password.

Once you have designated the server, account, and password and filled in the remainder of the fields as required, push the FTP IMAGES button to send the images.

Copy Image to Clipboard: To copy an image to the clipboard from the DICOM VIEWER, push the COPY TO CLIPBOARD button and the current image (as it is displayed in the image window) will be copied to the clipboard. This function is useful for including images in text documents or presentations. Run the recipient application (MS Word or Power Point for example) and Dicommunicator concurrently. Activate Dicommunicator and find the image you want to paste using the DICOM BROWSER or TEACHING FILE CASE BROWSER forms, open the DICOM VIEWER, move to the image of interest then click the COPY TO CLIPBOARD button. Change focus to the destination application (Word or Powerpoint) by either moving to the Taskbar on the bottom of the screen and activating the destination application or by sequentially pushing the ALT and TAB keys simultaneously until the desired application is active. Finally, paste the image to your document either by selecting PASTE from the Edit menu or by pressing ALT and V simultaneously. This process can then be repeated over and over to quickly import images into talks and text documents.

## Teaching File Functions (Go To Top)

Add Case:

Search Cases:

Browse/Add/Search ACR Codes:

View Case:

Edit/Delete Case:

Use Case Sets:

View Case as Unknown:

Add case to teaching file: The process of adding new cases to the teaching file starts from the DICOM VIEWER. The first step is to identify the images you want to add using the SELECT tool. Be sure you the teaching file database you want to use is selected in the pull down box just to the left of the ADD TO ETF button. By default, “Network” is used but under some circumstances you may want to use the “Local” teaching file (teaching file specific to the local computer you’re using rather than the networked/shared teaching file). Push the ADD TO ETF button and the TEACHING FILE ENTRY form will be opened. From this form, all of the necessary data fields that require manual entry can be filled in. All other data fields are taken care of because the Dicom images themselves contain several pieces of important data such as the Patient’s Name, the Date of Study, etc. which are all extracted automatically.

Dicommunincator will allow you to enter more than one teaching file for each patient but it does, however, show you a synopsis of previously entered cases for that patient. These synopsis are shown in the PREVIOUSLY ENTERED CASE subform at the top of the page. You can browse through these case synopses using the record selectors at the bottom of the subform. If you see that the case has been previously entered but want to add your selected images to the case, press the ADD TO PREVIOUSLY ENTERED CASE button. This will add the images to the teaching file archive and they will be available for review but you won’t need to add any more information as this was all done previously.

If you want to add a new case for this patient you will need to fill in data for six of the seven fields on this form. The CONTRIBUTER field is automatically filled in with the name of the user logged into the system. A brief history should be typed in the HISTORY field. Note that the age of the patient will be calculated automatically so it isn’t necessary to include the age in the history. The ANATOMIC SITE field is the text description of the ACR anatomy code. Note that all data entry in Dicommunicator is text based and that ACR codes for anatomy and pathology are generated automatically. As you type the anatomy descriptor in the ANATOMIC SITE field, the text will automatically fill in with possible matches from the ANATOMY table. If you don’t seem to find a match in the table using this method, you can use the ACR ANATOMY LOOKUP facility by pushing the LOOK UP button. More information on using the ACR LOOKUP TABLES is given below.

The ACR pathology description is entered in the DIAGNOSIS GROUPING field. Because the ACR pathology codes are incomplete and difficult to maintain, Dicommunicator supports ACR pathology coding but only to a limited degree. The ACR pathology listing provided with Dicommunicator is only provided to the second digit. This allows general classification of cases into broad categories. For example, a case of pneumocystis carinii pneumonia can be classified as pneumonia but no further subclassification is given in the DIAGNOSIS GROUPING field. Use the LOOK UP button to help browse the ACR LOOKUP DIAGNOSIS TABLE.

The fourth field, DIAGNOSIS, is a free text field that gives you complete freedom to enter whatever diagnosis you choose, whether it happens to be defined by the ACR or not. Dicommunicator maintains a dictionary of previously entered diagnosis to try and help with consistency and aid in data entry. As you enter the diagnosis text, Dicommunicator will attempt to match with previously entered diagnosis. If you enter diagnosis that hasn’t previously been used, Dicommunicator will check for similarly spelled words in the dictionary and ask the user to verify spelling, etc.

The CATEGORY field options can be defined by the manager of your local system to meet local needs from the MANAGE CATEGORIES form. By Dicommunicator default, the user is asked to classify the case as being of “Beginning”, “Intermediate”, or “Advanced” difficulty. These category values can be added too, deleted, or changed by the manager using the EDIT CATEGORIES tool.

The final field is optional. A short free text comment can be entered as needed. Note that full formal write up support is not yet included in this teaching file program but that the program has been written with this in mind and that it will be made available in the future.

After filling in all the required fields (History, ACR SITE, DIAGNOSIS GROUPING, DIAGNOSIS, and CATEGORY) and adding an optional COMMENT, the case can be entered by pushing the SAVE AS NEW CASE button. If at any time you decide to abort the case entry push the RETURN WITHOUT SAVING button.

If you are adding several imaging studies to a case (i.e. Chest radiograph and a Chest CT in a patient with Cystic Adenomatoid Malformation) the TEACHING FILE ENTRY form will open for the first set of images entered but as long as you continue to add images/studies from the same patient you will not be asked to enter data manually again.

Browse/Add/Search ACR Anatomy/Pathology codes: The ACR ANATOMY LOOKUP and ACR PATHOLOGY LOOKUP forms can be used as electronic books to browse through the codes entered into the respective anatomy and pathology dictionaries. These forms are also a mechanism to add new codes. These forms are opened from the TEACHING FILE ENTRY form by pushing the respective LOOK UP button.

As these two forms are very similar, documentation is given for the Anatomy form and this information should help in using the diagnosis/pathology form as well. As the ANATOMY BROWSER form opens, start by selecting the organ system of interest from the SYSTEM pull down. The BROWSER window will automatically update with the first level of possible choices. As you click on an entry in the BROWSER window, the window will be updated with text of all codes that are subsidiary to the selected code. The currently selected code is also placed in the PICK LIST window. You can move up and down the tree by sequentially making selections from the BROWSER window and moving back up the tree by pushing the up-arrow button to the left of the BROWSER WINDOW. When the text you are interested in appears in the PICK LIST window, highlight that text by clicking on it and push the SELECT button to transfer your selection to the TEACHING FILE ENTRY form.

If you are having trouble finding what you need, it may be helpful to use the SEARCH capabilities of this form. There is a similar design to the SEARCH in these ACR LOOKUP forms and the general TEACHING FILE SEARCH form. If there is no text in the ACR ANATOMY or ACR PATHOLOGY tables to describe what you need, you can make new entries to the table by pushing the ADD NEW button. This will cause a small pop up form to appear. Simply enter the new text and new code and push the ADD button to update the dictionary. If you add codes, be sure that all other codes higher in the hierarchy are also in the dictionary or you will be unable to browse down the tree and find the new code you entered.

View teaching file cases: You can either view teaching files in a mode where all entered data fields are visible or in a mode where some fields (such as diagnosis) are hidden. See VIEW TEACHING FILE CASES AS UNKNOWNS below for documentation of this second mode. From the MAIN MENU, press the VIEW TEACHING FILE CASES button. The CASE BROWSER window will be opened. As this form opens it by default selects the “Network” teaching file. It is intended that this “Network” file would be used by several different computers as a shared resource. If there are no cases in the “Network” teaching file, Dicommunicator tries to open the “Local” teaching file instead.

As the form opens, all cases in the teaching file are available for review. There are RECORD SELECTORS at the bottom of the page that allow you to move through the cases. Pushing on the appropriate arrows will allow you to Move First, Move Prior, Move Next, and Move Last through the cases. Note that these record selectors are standard with Microsoft Access and learning to use them will help in all kinds of Access Applications.

As you move to a particular case, the STUDY subform updates, showing the studies that have been entered in the teaching file for that patient. To view any study, either click on the STUDY DESCRIPTION (written in light blue) or select the current study and push the VIEW TF IMAGES button. This will cause the DICOM VIEWER to open and automatically load the images from the selected study. All of the DICOM VIEWER FUNCTIONS and IMAGE EXPORT FUNCTIONS are available as this viewer opens (Image export, Manipulation, etc.). After viewing the images, push the RETURN button to give control to the CASE BROWSER.

If Dicommunicator has a network communication with a Dicom Archive (i.e. you have a full institutional PACS system) you can also pull the full study to the viewer rather than limiting the images to those that were selected by the person entering the case. To pull and view these images from the archive, select the study of interest and push the VIEW FROM ARCHIVE button. This will open the DICOM VIEWER which will at first contain no images. As the images are received, they will be available for display and the DICOM VIEWER will automatically update. Note that this procedure may take some time depending on the speed of your PACS and the availability of archived studies.

If you are interested in seeing what other studies the patient has had push the PULL MORE STUDIES button. This will open the PACS BROWSER form, select a QUERY HOST that is specified as a Dicom Archive, and query that host for all prior studies for the current patient. You can then pull those studies locally or view them directly as described above.

Search cases: Searching cases can at first be perplexing but as one comes to understand the capabilities of this system it becomes a powerful tool. Dicommunicator provides a simple SEARCH tool but the most powerful way to search is to use the native Access Search tools.

The Dicommunicator search is invoked by pushing the SET UP SEARCH button. A form is opened where you can select the field to search, specify the matching criteria ( starts with, contains, exactly matches, etc.), and finally specify the text you want to match. Up to 5 fields can be concurrently searched in this manner and with each new field you add you must specify which Boolean operator you want to use (AND or OR). After you have completed your criteria, hit the return key to fill in the CRITERIA text box and push the DO SEARCH button on the CASE BROWSER form. If you want to abort a search instead, push the ABORT SEARCH button.

A brief review of Access Search tools is provided here but the Access Help documentation will give more detail.

The most important search tools are provided in a tool bar at the top of the form as a series of icons (AZ, ZA, a funnel, etc.). A brief description of each of these tools follows. To sort any field alphabetically or numerically highlight that field by clicking on it and then push the red AZ icon if you want to sort on that field in ascending order or the ZA icon if you want to sort in descending order. To find all cases that have a field exactly matches the corresponding field in the current record highlight the field of interest and push the funnel icon with the lightning bolt.

The most versatile way to search is to use the filter on form tool (funnel with a little form icon). By pushing on this icon you open a blank copy of the CASE BROWSER form and you can enter text in any field you want to specify the search criteria. The * symbol is used as a wildcard. So for example if you wanted to find all Wilms tumors you would go to the DIAGNOSIS field and type Wilm*. If you wanted all neoplastic like conditions in the skull and contents organ system you would go to the ACR CODE field and type 1*.3* .

After you have performed a search and want to turn the search off and return to all cases push on the funnel icon with a mark through it. To restore the last search, push the funnel icon.

Edit/Delete teaching file case: As you browse through teaching file cases, the EDIT/DELETE button will appear on cases where you are authorized to make changes or delete. You are authorized to make changes/delete all cases if you are a manager. Otherwise, you can only change cases you personally entered. This limitation protects the teaching file from unauthorized tampering.

To edit or delete a case push the EDIT CASE or DELETE CASE button. For case editing the TEACHING FILE ENTRY form is opened (the same form used to add a new case). Browse through the previously entered cases on this patient using the record selectors. Once the case is active you can make changes to any data entry field in the body of the form. Press SAVE CHANGES to save edits.

Produce case sets: The development of case sets is the digital equivalent of packaging a group of interesting cases together in a bundle to be used for teaching or testing residents. To bundle interesting cases into case sets, first have a manager create a new case set for you. After the set is created, it will be empty (no cases have yet been bundled) but the set is given a name such as “Dr. X’s interesting cases”. The manager will give you ownership to the case set when he creates it so that you will be able to add and remove cases from the set. If you are a manager, you have access to all case sets. Otherwise, you can only modify your own case sets.

To add cases to a case set open the CASE BROWSER form and go to the CASE SETS pulldown and select the CASE SET you want to work on. As you move through the cases in the teaching file, the ADD TO CASE SET or REMOVE FROM CASE SET buttons will be active (depending on whether the current case is a part of the set or not). To add or remove the case from the set simply push the button. You can apply the SEARCH TOOLS to find cases you want to add to your set. The case sets themselves become useful when VIEWING CASES AS UNKNOWNS.

Review teaching file cases as unknowns: Viewing teaching file cases as unknowns is very similar to general CASE BROWSER function with the exception that certain fields such as the diagnosis are hidden until you have committed yourself to a diagnosis. From the MAIN MENU press the REVIEW TF CASES AS UNKNOWNS button to open the UNKNOWN CASE BROWSER form. Be sure you are logged into the system as yourself because Dicommunicator keeps track of which cases you have viewed and will not show cases you have already seen. There is one exception to this rule. If the name of the logged in user is “Resident”, the system will not update the table that keeps track of which users have viewed a case so that the same cases can be repeatedly reviewed in multiple sessions under this login.

As the form opens, all of the teaching files in the network teaching file are available for review. The SEARCH TOOLS outlined above can be used if desired to reduce the number of cases (i.e. you could push the filter on form icon, type Skull and Contents in the System field and Beginning in the Category field to view easy CNS cases).

The Case Set selector can be used to select a particular bundle of cases for review. Go to the CASE SET pull down and select the case set you are interested in viewing. Dicommunicator will automatically select all cases in that case set that you have not previously viewed and load them.

Image viewing and general form operation are the same as for general TEACHING FILE VIEWING. After you have viewed the case and have decided on a diagnosis, type the diagnosis in the YOUR DIAGNOSIS textbox and push the SUBMIT button. When you do this, three important functions happen; 1- the hidden fields including the diagnosis are restored to view, 2- your answer is stored in a table that keeps track of all answers offered for the case, and 3- a table entry is made so that the next time you enter UNKOWN CASE BROWSER this case will not load.

After you have submitted your diagnosis the VIEW DIFFERENTIAL DX button appears. By pushing this button you can see what others who submitted diagnosis for this case thought. The Differential diagnosis is sorted by frequency so the most common answers appear at the top of the list.

## Conferencing Functions (Go To Top)

Pull conference:

View conference studies:

Pull case(s) for conference: Dicommunicator can be used to pull studies to the local database for conferences. This is particularly useful when performed in conjunction with the production of teaching files because the most interesting cases are frequently presented in a case conference and by linking the conferencing and teaching file functions it is easy to add interesting cases. The manager maintains the list of conferences or “scopes”. A “scope” is a reason for pulling a case into the local database. Some scopes such as “Tumor board”, “Surgery Conference”, etc. are conferences and cases pulled using these scopes will be accessible from the CONFERENCE BROWSER. Not that each scope has an expiration time, a time that a study will remain on the system.

To pull studies for a conference, open the PACS BROWSER form and select the desired conference/scope from the CONFERENCE pull down. If the pull down does not include the conference you want, have a manager add this conference to the conference list using the MAINTAIN SCOPES form. Once the correct conference has been specified, browse cases on your PACS Dicom Archive and pull them to the local database using the QUERY/RETRIEVE capabilities of the system. Note that whatever scope is active when you pull a case using the RETRIEVE button will be assigned when the study arrives. Sometimes, you may want to add a case to a conference even though it was pulled under a different scope (for example, if you pulled a study from the PACS under the “Local Review” scope but later want to add it to the “Tumor Board” list). With the QUERY HOST set to “Local” change the CONFERENCE pull down to the desired conference and press ADD TO CONFERENCE. If images are already local you do not need to pull them again so you can answer “no” when asked if you want to re pull. The conference cases will remain resident on the system for the number of days specified by the CONFRENCE LIST as set up by the manager (i.e. the system auto-purges old conferences so you don’t need to do purge manually).

View conference cases: The CONFERENCE BROWSER uses a very similar interface as the CASE BROWSER. Typical record selectors are found at the bottom of the page. Start by selecting the conference of interest from the CONFERENCE pull down. All patients with studies pulled for this conference are than displayed. As you move from one patient to the next, the STUDY subform is updated giving the studies that have been pulled for that patient. You can view the images for a particular study by either clicking the blue study description or clicking the study record selector and pushing the VIEW IMAGES button. The DICOM VIEWER will open and all images in the selected study will be loaded. All VIEWER FUNCTIONS will be available. If the computer is connected to a network, IMAGE EXPORT FUNCTIONS will be available as well.

If the computer is connected to the network during the conference, additional studies can be pulled “on the fly”. This is done either by pushing the PULL MORE STUDIES button if you want to pull more studies for the current patient or by closing the CONFERENCE BROWSER and opening the PACS BROWSER. Be sure you set the CONFERENCE pull down on the BROWSE PACS form before doing the QUERY/RETRIEVE so the study will be added to the right conference. If you are in the CONFERENCE BROWSER form and anticipate that additional studies have arrived for the conference push the UPDATE CONFERENCE button to refresh the conference list.

## Cooperative Group Functions (Go To Top)

Add/Edit Cooperative Group Lists:

Register Patient:

Maintain Study List:

Submit Studies:

Maintain cooperative group list: Dicommunicator makes it possible to submit imaging studies to remote sites via FTP and Email transfer. This is necessary because most institutions will not allow Dicom transfers outside of the institution because of security / firewall limitations. All cooperative group access is achieved by pressing the MANANGE COOPERATIVE GROUP DATA button on the MAIN MENU. Pressing this button opens the COOPERATIVE GROUP STUDY LIST form. Press the MANAGE COOPERATIVE GROUPS button to view, add, and edit the descriptive parameters for cooperative groups. For each group you must designate the COOPERATIVE GROUP NAME and specify a preferred conduit for image transfer (Email, FTP, or CDROM). If you specify Email as the conduit you should supply an address name and email address. For example, Children’s Oncology Group Submissions are sent to Email Name: Qarc and Email Address: DicommunicatorCOG@qarc.org . If the preferred conduit is FTP, put the address of the FTP server, the Login Name, and Password designated by the cooperative group in the appropriate fields. After assuring that the cooperative group connection data is set up, establish a list of study protocols that you will be registering patients into. To edit the list, push the EDIT STUDY ID’S button.

Register Cooperative Group patients: Data sent from Dicommunicator to any cooperative group can only occur for patients who have been “registered”. Registration of a patient maps the local demographic fields Name and PatientID to RESEARCH ID (the study registration number provided by the cooperative group when a new patient is entered on study) and STUDYID (an identifier telling which particular research protocol the patients is participating in).

The process of registration is really just a simple mapping of the Patients local demographics with what will be the study demographics. To register a patient, first get the RESEARCHID and STUDYID for the patient from the cooperative group office. From the COOPERATIVE GROUP STUDY LIST form press the REGISTER PATIENT button. The COOPERATIVE GROUP REGISTRATION form will open. If you know the patient’s NAME and ID you can enter them manually in the corresponding text boxes then fill in the RESEARCH ID and STUDY ID field values. Alternatively (and more optimally) you will get the patient’s NAME and PATIENTID by look up. Press the LOOK UP button. This will open the PACS BROWSER form. Use standard Query/Retrieve capabilities to identify a study performed on the patient, select that study, and push the REGISTER PATIENT button. As control returns to the COOPERATIVE GROUP REGISTRATION form manually enter the correct RESEARCH ID and STUDY ID and press REGISTER to complete the registration.

Maintain list of studies to be submitted: If you have a PACS system, Dicommunicator will automatically update the list of imaging studies that have been performed on registered patients. Use the record selectors to move to the patient of interest and press the UPDATE STUDY LIST button. For this function to work, at least one of the computer connections the manager has set up must be a Dicom Archive. The list of imaging studies will be automatically updated and their statuses (pending, sent, failed) will be updated.

Submit studies electronically: You can either submit imaging studies to the cooperative group manually by sending them one at a time or you may send in batch mode. To send one study at a time, Update the study list by pushing the UPDATE STUDY LIST button and be sure the study has been pulled to your local database by attempting to view it by pushing the STUDY DESCRIPTION or VIEW IMAGES button. If the study is not local, a form will pop up and allow you to pull the study. After the study has arrived to the local database, select the study you want to send and press SEND THIS STUDY. The FTP or Email form will be opened and the study will be sent without any additional input required from you. If you want to send several studies in a batch, change the value in the box below the MARK THIS STUDY button to “SEND”. Move through the studies and push the MARK THIS STUDY and a “pending” status will be applied for each study you mark. By pushing MARK THIS STUDY, you automatically initiate the process of pulling the study from the Dicom Archive to the local database. Before sending these studies, however, verify that they have arrived to the local database by trying to view them. When you are ready to send the studies, push the SEND MARKED STUDIES button. If the study is successfully sent, the status will change to “SENT”. Note that there is no absolute guarantee that the studies actually arrive at the cooperative group, the change of status only means that the study was successfully sent to your email or FTP server.

### Manager Functions (Go To Top)

Edit Computer Connections:

Maintain Security:

Edit Case Set List:

Maintain Teaching File Category Fields:

Maintain Auto-masks:

Maintain FTP Connections:

Maintain Modality List:

Maintain Presets:

Maintain Scopes:

Maintain Global Variables/Paths:

Reattach Tables / Reset System:

All management functions are activated by pushing MANAGER FUNCTIONS button on the MAIN MENU. This will open the MANAGER EDIT FUNCTIONS form. Each of the edit/management functions below will allow you to customize the function of Dicommunicator to your particular institution. For each of these functions, standard arrow record selectors are given and an ADD NEW button allows you to enter new values in the table.

Edit Allowable Computer Connections: Edit this table to set up the allowable computer connections. Dicommunicator comes with several connections already defined (Local, CDROM, Browse, and Email) for all but the Email, the IP address (node) is “Local” . You must enter the IP address for your SMTP Email server for the “Email” AET to use the email export functions.

For the Dicom protocol, the port should always be 104. Make sure that when you add a new Dicom connection that the AET (application entity title) is exactly correct. This value is case sensitive. Your PACS administrator will need to give you the AET information for the Dicom archive server(s) on your network. For AET’s that will support Dicom Query/Retrieve you should check the AUTOQUERY box to true. If you have a full PACS system, enter the Dicom Archive Server AET, give it port 104, enter it’s IP address, check the AUTOQUERY box, and specify the PROTOCOL as “Dicom”. This will allow you to Query the server. Note that in order to pull studies from the server your PACS administrator will need to enter the AET of this Dicommunicator application (one distinct AET for each computer running Dicommunicator which you define in the GLOBALS AND PATHS table), the internet address of this computer, and give you rights to pull images and (if desired) push images to the archive. You can check that the node (IP Address) you specified is open by pushing the PING button.

Maintain Users/Security: Dicom uses standard Access workgroup security. If you are using Dicommunicator on a network and installed the network files to a shared drive, the workgroup (security database) for all networked computers is found at NetworkRootDirectory\Dicommunicator\BackEnd\Security\DicommunicatorSecurity.mdw . When you are running Dicommunicator in local mode (without any network shared files) the workgroup path is LocalRootDirectory\Dicommunicator\BackEnd\Security\DicommunicatorySecurity.mdw . By using a shared workgroup you can centrally manage users for all computers running Dicommunicator in the system. We recommend that the network security workgroup file be used as the master and that a very simplified version of the workgroup be kept in the local path for use when the network is down or when the computer is off-line. If you are running Dicommunicator on a computer that is sometimes connected to the shared network drives and sometimes freestanding, you should place shortcuts on the desktop for a network and local Dicommunicator startup (The only difference between these two short cuts is the path to the workgroup one referencing the shared mdw and the other the local mdw). Use this path in the Dicommunicator Network Shortcut that you will use to launch the application (see INSTALLATION NOTES above).

The DicommunicatorSecurity.mdw comes with a user named manager (password manager) that you can use to begin with. When you press the EDIT SECURITY button, a form will open that will allow you to; 1- add a new user, 2- give the user a password or change the user’s password, 3- change the user’s membership to the CRA and Manager groups and 4, delete a user. The mechanism for performing adding users should be self-explanatory. Each user should receive a personal login as this login will be used to credit persons for cases entered into the teaching file as well as control the studies pulled up for review when the REVIEW CASES AS UNKNOWNS. Note that all passwords are case-sensitive. Be sure to push the SAVE button after you have added a new user.

By default, when you add a new user they become members of the USERS group. As members of this group they can not access the COOPERATIVE GROUP MANAGER FUNCTIONS or the MANAGER FUNCTIONS. Users must be members of the MANAGER group to perform manager functions. The CRA group is specifically for Cooperative Group Data Managers. By making a user a member of this group, they will be able to access the Cooperative group functions but will not have access to teaching file functions. To change membership in a group, select the group from the GROUPS Pull down and push the check box to either add them or delete them from that group. You can not delete a person from the Users group (all users are by definition members of this group).

Edit Case Set List: Case sets are groupings of cases used primarily as teaching sets for the UNKNOW CASE BROWSER form. To add a new case set, push the EDIT CASE SETS button to open the form. Give the new case set a NAME, an EXPIRATION DATE (date when the case set references will be purged), and an owner. The designation of the owner is important because if you assign the wrong owner they will be unable to add or remove cases from the case sets.

Edit Teaching File Case Categories: The CATEGORY field of the teaching file is designed to allow separation of cases based on some parameter thought to be important to the institution. By default, Dicommunicator comes with 3 categories (beginning, intermediate, and advanced) intended to separate the complexity of the cases and allow rapid searching for suitable case material for teaching conferences. Any number of categories values can be established and the 3 categories listed above can be eliminated without compromising the function.

Edit Auto-masks: This important function is vital to patient security. The auto-mask function allows Dicommunicator to mask out a portion of the image in black (intended to overwrite Patient identifying information contained in Dicom images acquired with secondary capture devices including US). For each acquistion station in your system that generates images with demographics included in the pixel data you should make an entry in the auto-mask table. Your PACS administrator should be able to help you identify the STATION NAME of the acquisition station (this is a case-sensitive value). You set the size and position of the mask by entering the top and left coordinates of the box (these will usually be 0 and 0 respectively) and the height and width of the box in pixels.

If, rather than guessing where the automask boxes should be placed you want to have Dicommunicator automatically update these values for you from the viewer, press the USE VIEWER button. After you have done this, you can then move to the PACS BROWSER and Pull or select a study that originated from the station of interest. Open the images for viewing and use the MASK TOOL to draw a mask over the identifying demographics you want to hide. You will be prompted to accept the changes to the automask table. Note that if you log off Dicommunicator then log in again, the automatic updating of values in the automask table will not occur (i.e. you can use the mask tool from the viewer without being prompted to update the auto mask table values). Each time you want to change the automask tables, you must enter the EDIT AUTO-MASKS form and push the USE VIEWER button.

Maintain FTP connections: Parameters for possible FTP connections are kept in this table. Enter a familiar DESCRIPTION, the IP ADDRESS, a LOGIN, and a PASSWORD for each connection. Sites frequently allow you to login under the “anonymous” user login and use your email address as the password. Check with the FTP site administrator for your connect requirements. You can check that the node (IP Address) you specified is open by pushing the PING button.

Edit Modality List: This table contains a list of all modalities supported by your PACS system. Most of the modalities should already be in this table but it is possible that your PACS vendor has used a different descriptor than is given here (i.e. MRI instead of MR). Be sure you have all modalities defined by your PACS entered in this table.

Edit Viewing Presets: This table contains typical window/level presets. Note that presets are modality specific so that when a study is loaded into the DICOM VIEWER only the presets defined for that modality will be listed in the PRESETS pull down. To add new presets, first open images in the DICOM VIEWER for which the presets could be applied and manually window and level. Note the window and level values then return to the MAIN MENU form and select MANAGER FUNCTIONS. Press the EDIT PRESETS button and ADD NEW. Enter the MODALITY, a logical name for the PRESET, the WINDOW, and the LEVEL values.

Edit Conference Lists / Scopes: Conference lists/ or “scopes” are essentially reasons why studies would be pulled into the local database. The ambiguity in naming this table is that while most of the values in this table are conferences, some are not. There are two main purposes for this table. The scopes are used to assign studies to a conference as they are retrieved from a Dicom Archive and the scope’s DAYS VALID parameter tells the system how long to keep the study on local hard drive before deleting it. One of the nice features of Dicommunicator is that it auto manages the hard disk so that you don’t have to purge studies manually. Every time someone logs onto the system it checks for any studies that have exceeded the DAYS VALID time limitation and those studies are purged.

The CONFERENCE parameter is used to specify whether as a study comes in from the archive it should be added to the conference list or not. For example, if you added “Surgery Conference” as a scope you would want to check the conference box as well so that cases could be specifically pulled for this surgery conference and be listed when you open the CONFERENCE BROWSER. On the other hand, if someone wanted to pull cases because they were preparing a talk and wanted to keep the studies on the system for 2 months you might enter “Lymphoma Talk”, assign 60 to DAYS VALID, and leave the CONFERENCE box unchecked.

After you add a new scope to this table, it will be reflected as an option in the CONFERENCES pull down on the PACS BROWSER form.

Maintain Global Variables: This important table is used to establish set up parameters and paths. After installation, you will need to go through this table and assign variables and paths for your specific installation. Once those variables are correctly set, they shouldn’t need additional changes.

GCDROMR is the path to a writeable CDROM drive. The system default is “unknown”. Unless you have a writable CDROM drive installed and establish it’s path with this variable all CDROM write functions will be disabled. You can use the BROWSE button to find the drive.

GCDROM is the path to your CDROM. This path will be used by the PACS BROWSER when you set “CDROM” as the QUERYHOST.

GNETWORKROOTPATH and GLOCALROOTPATH are two critical paths that tell Dicommunicator where to find local and network tables. Note that when you are using Dicommunicator in isolation and all files are installed on the local drives only then GNETWORKROOTPATH should equal GLOCALROOTPATH (i.e.GNETWORKROOTPATH doesn’t need to be on a network drive). When you install Dicommunicator, you are asked to select a root directory for installation of files. The installer then copies all Dicommunicator directories and files into this root path. GLOCALROOTPATH should give this path. For example, if during installation you specified “C:\” as the root path, the installation program created a directory named “C:\Dicommunicator\” and copied files into it. For this example, GLOCALROOTPATH should be “C:\”. You can use the BROWSE button to find the root path. If you have not installed a network/shared copy of the Dicommunicator files, make GNETWORKPATH the same as GLOCALROOTPATH. If, on the other hand, you installed shared files at “W:\RADFILES\ “ then GNETWORKPATHS should be set to “W:\RADFILES\”. Again, you can BROWSE to find this path.

GMYAETITLE is the Dicom Application Entity Title you are using for this copy of Dicommunicator. Each computer in the system must have a unique AETitle and that title must match exactly with the PACS systems tables (including case). If you do not have a local PACS and will not be pulling studies from any devices then GMYAETITLE can be anything you want. Otherwise, get with the PACS administrator, come up with the name and be sure it is entered correctly here and in every Dicom device that it will query.

GINSTITUTION is the name of your hospital. The next two globals are important in maintaining the Dicom standard. Because there will be occasions when this version of Dicommunicator will produce Dicom images, it is important that those images be given unique identifiers or UIDs. Dicommunicator has been assigned a UID and that number is embedded in the code. But, it is important that two additional numbers be appended to that UID in order to assure that every Dicom image ever generated by Dicommunicator has unique identifiers. The GINSTITUTIONUID is a number you should receive from Dicommunicator distributors. If you have lost this number, email Rhanusik@Qarc.org for that number. For each computer you install Dicommunicator in your institution set GINSTITUTIONUID with that number. The second number is a unique device UID, GDEVICEUID. This is just a unique number for each different computer within your institution that has Dicommunicator installed. For example, use 0 for the first machine you install, 1 for the next, etc. If you fail to set GDEVICEUID to a unique value strange problems will possibly occur such as mixing of images between different patients.

Reattach Tables (Reset System): Push this button to reset Dicommunicator and reestablish links to tables. If you change GLOCALROOTPATH or GNETWORKROOTPATH values in the GLOBALS/PATHS tables you will need to push this button to make the correct links between Dicommunicator files. The same function occurs if you quit Dicommunicator and restart it.